2015 Distributor Form

Please complete the following form by Tuesday, March 3, 2015, for inclusion in Pizza Today’s May 2015 Distributor Guide. For questions, please contact Associate Editor Denise Greer at dgreer@pizzatoday.com // 1-502-736-9503.

If you would like for us to pick up last year’s 2014 Distributor Guide information for your company, please include your company’s name in the subject line and “Pick up my 2014 Distributor Guide information” in the body of e-mail to dgreer@pizzatoday.com.

If you are human, leave this field blank.

Company Name
*

Address
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City
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Dropdown
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Zip Code
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Phone Number
*

Email Address
*

Website
*

Owner(s)/Top Officer:
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Year Established
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Product Line (brand names):
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Number of restaurants served:
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Number of sales staff:
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Number of trucks:
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Service Area -- States (Check all that apply):
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Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Approximate percentage of your business that is pizza related:
*

Approximate number of pizza restaurants you serve:
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Do you offer online ordering to your customers?
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Yes

No

Pizza-related ITEMS that you sell:
*

Pizza-related SERVICES you offer:
*

Other services:

INTERNAL USE ONLY -- 2015 Distributor Form completed by: (Name and title)
*

This individual will receive e-mail notification when it is time to complete the Distributor Form each year.